CT-guided hook-wire localization of small peripheral lung nodules for video-assisted thoracoscopic surgery (VATS)

Lung nodules judged too small or too far from the pleural surface to be seen or palpated during video-assisted thoracoscopic surgery (VATS) need to be localized with a marking device or stain, in order to assist their identification intra-operatively. We report on two patients with lung nodules measuring between 7 and 20 mm that could only be seen by lung-window display during CT examination. Their intra-operative identification during VATS was presumed difficult by the surgeon. CT-guided hook-wire localization of the nodules was performed in less than 1 hour prior to VATS. The patients experienced little pain; no pneumothorax or bleeding was noted. The surgeon, using VATS, successfully resected both lung nodules under the guidance of hook-wires without complication. Hook-wire localization of small lung nodules prior to VATS is safe; it enabled accurate resection of small lung nodules during VATS and reduced the operating time.